Blog | Friday, February 24, 2012

QD: News Every Day--Meaningful use adoption sparse as CMS previews stage 2


Physicians adopting electronic health records (EHR) are still spurning meaning use criteria, two industry surveys showed, even as the government has released details on expanding the criteria.

Physicians in groups of 10 or more are more likely to have adopted EHRs, even while remaining unfamiliar with regulatory issues, meaningful use criteria, and ICD-10 requirements, for example, according to a survey by the Deloitte Center for Health Solutions.

The company surveyed 501 physicians online (acknowledging this might bias responses to technology users). Because practice size might significantly impact results, the initial respondents were resampled, and 307 responded.

Nearly two-thirds said use an EHR, more among large practices (78% of 10 or more practitioners, 68% of 2 to 9 practitioners, 54% of solo practitioners). Solo practitioners are also unlikely to have plans to implement them (45% vs. 15% of group practices).

While physicians largely agree that EHRs are valuable in improving quality (84%) and important to managing patient care (79%), more than six of 10 physicians state that EHR use has not improved diagnosis accuracy or treatment planning, the report said.

It continued that while two-thirds of physicians agree that HIT can improve quality of care in the long run, two-thirds also believe that "the hospital-physician relationship will suffer as physician privileges are put at risk to comply with hospital standards for meaningful use," the report states. "Nearly 90% of all physicians believe that hospitals are more advanced in HIT than their own offices; more than three-quarters of physicians view HIT as a reason to collaborate with hospitals."

Reasons for not adopting EHRs included upfront financial investment (66%), operational disruptions (54%), privacy concerns (22%), vendor selection challenges (15%), and lack of incentives (13%).

Another survey concluded that while 42% of health care providers in all settings use EHRs, 39% have no plans to implement stage 1 of meaningful use. IVANS, Inc., a national health information exchange, announced the results in a press release.

Of that 39% with no plans to implement meaningful use, 26% of them are providers in hospitals and private practices that are eligible for incentives for doing so.

According to the company, 33% of providers surveyed said budgetary concerns are their biggest challenges, while 21% cited technology requirements. The survey was conducted electronically among 700 health care providers from across the U.S.

In stark contrast, the Centers for Medicare and Medicaid Services (CMS) are moving ahead with stage 2, the agency announced yesterday.

CMS announced that In Stage 1, providers and hospitals must meet or qualify for an exclusion to all of the core objectives and 5 out of the 10 menu measures in order to qualify for an EHR incentive payment.

CMS proposes for stage 2 that providers must meet or qualify for an exclusion to 17 core objectives and 3 of 5 menu objectives. Hospitals must meet or qualify for an exclusion to 16 core objectives and 2 of 4 menu objectives.

Other requirements optional in stage 1 but required in stage 2 include:
--changes to the denominator of computerized provider order entry,
--changes to the age limitations for vital signs
--elimination of the "exchange of key clinical information" core objective from stage 1 in favor of a "transitions of care" core objective that requires electronic exchange of summary of care documents, and
--replacing "provide patients with an electronic copy of their health information" objective with a "view online, download and transmit" core objective.

Even though there's been limited adoption of stage 1, there are some easy ways to achieve meaningful use criteria using an EHR. And, Farzad Mostashari, MD, the government's national coordinator for health information technology, spoke specifically to his fellow internists how they can best serve their patients and take advantage of incentives.

And, AmericanEHR Partners, a collaboration that include the American College of Physicians, reported last year that at least one week of training correlated with improvement in the reported usability of advanced EHR features (e.g. checking patient formulary, importing medication lists, and medication reconciliation). The full report, "The Correlation of Training Duration With EHR Usability and Satisfaction: Implications For Meaningful Use," and a corresponding chart pack can be downloaded.

ACP also make meaningful use resources available on its website.